A Brief Review

1. HYPERURICEMIA
Focus onTreatment
AdeWijaya, MD – February 2018

2. Introduction
■ Overproduction or under-excretion of uric acid, a product of purine catabolism
physiologically excreted in the urine
■ Closely related to cardiovascular and renal complications
■ Gout

3. When to treat ?
■ Two or more acute gout attacks per year,
■ Presence of tophi,
■ Chronic kidney disease (CKD) stage 2 or more,
■ Presence of renal stones,
Target < 6 mg/dL

6. Key recommendations for the
management of hyperuricemia
A careful management of chronic hyperuricemia
• Correct education of patients to improve adherence and optimize the results
• Modifiable risk factors:
• Obesity (Weight loss and restriction of dietary purines)
• Reduce/abolish beer, sodas, spirits, and fructose-rich beverages consumption
• Increase the intake of vitamin c
• Reduce or stop Loop and thiazide diuretics therapy
• SUA levels should be under the target value of 7 mg/dL
• Assess the global cardiovascular risk of patients with elevated SUA levels
• Urate lowering therapies with XO inhibitors should be prescribed as soon as the diagnosis is made

7. Allopurinol dose:
■ The daily dose of allopurinol recommended for reaching target values of uricemia is
100–600 mg, although sometimes it must be up to 900 mg in patients without
impaired renal function
■ A higher dosage of allopurinol (300 mg twice daily) has resulted in quality
improvement of vascular biology and left ventricular hypertrophy
■ In obese or hypertensive adolescents, the dosage of allopurinol administered was 200
mg twice daily
■ Fatal hypersensitivity reaction

8. Summary
■ A multifactorial pathological condition
■ Closely related to CVD and renal incident development
■ Improve endothelial function at higher dose
■ Target < 6 mg/dL

9. References
■ Gliozzi, M., Malara, N., Muscoli, S., & Mollace,V. (2016).The treatment of
hyperuricemia. International journal of cardiology,213, 23-27.
■ Bove, M., Cicero,A. F. G.,Veronesi, M., & Borghi,C. (2017).An evidence-based review
on urate-lowering treatments: implications for optimal treatment of chronic
hyperuricemia.Vascular health and risk management, 13, 23.
■ Sattui, S. E., & Gaffo,A. L. (2016).Treatment of hyperuricemia in gout: current
therapeutic options, latest developments and clinical implications. Therapeutic
advances in musculoskeletal disease, 8(4), 145-159.